Evidence of meeting #19 for Indigenous and Northern Affairs in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was care.
A video is available from Parliament.
5:55 p.m.
Conservative
Jamie Schmale Conservative Haliburton—Kawartha Lakes—Brock, ON
Can you tell me about that? Will you run me through that process? How does that work? First, you dust it off...?
Seriously, can you run me through that?
5:55 p.m.
Pharmacist, Little Current Guardian Pharmacy, As an Individual
I don't know the mechanism, but we send a fax to the NIHB for approval. Sometimes we follow-up three or four days later and say that we sent an approval and ask if there is any response. They say they didn't get it. Well, I know I sent it and I have confirmation that it was sent, but they haven't received it, so we have to start the process again. Then, I believe they would fax the document to the doctor's office. The doctor's office would fax it back to NIHB and then NIHB would fax us back at the pharmacy.
Yes, it can get lost. The network or the fax is busy, or whatever it is. It does happen that faxes get lost.
5:55 p.m.
Conservative
Jamie Schmale Conservative Haliburton—Kawartha Lakes—Brock, ON
The fax gets busy. That's something I haven't heard in a while. Say it's 2005....
Has anyone brought up the fact that we don't need to use faxes anymore and it's probably more efficient to do something else?
5:55 p.m.
Pharmacist, Little Current Guardian Pharmacy, As an Individual
Yes, but that is probably a system that has to be integrated between the departments, ESI, the doctors' offices, the NIHB call centres and the pharmacies. Yes, there's Internet, but which system has to integrate within the others? It's a process. That's an IT issue that I don't know much about.
5:55 p.m.
Conservative
Jamie Schmale Conservative Haliburton—Kawartha Lakes—Brock, ON
That sums up government perfectly right there. Oh my goodness. Wow.
Ms. Grier, you are nodding your head on that. This is amazing. This really is. Do you want to add to that?
5:55 p.m.
Lead, Indigenous Initiatives, Canadian Counselling and Psychotherapy Association
I echo his sentiment that we're at the mercy of the professionals who are around that in this environment.
Right now I believe the federal government is exploring the racism going on in the health care system. Again, we're at the mercy of individuals who may not always have our best interests...but they do enjoy the funding they receive. They may not have the cultural competency to work within our populations. We're at the mercy of these individuals.
I echo Lori's comment on people who do not want to do business with NIHB. I know a lot of practitioners who say no. They say they don't get paid on time. There are too many bureaucratic errors. There are all of these issues, and they won't do it. We're actually creating more barriers and wanting more.... The competent professionals that we need under NIHB are leaving.
I'm not saying it's all of the clinicians out there. There's a diversity of course. There's a spectrum. Really, in Canadian society, if you want to pick a therapist, you have the choice to go and try people out. The therapeutic alliance between the client and the therapist is the most important aspect. I work with young people who tell me that it's so good to work with me, because they had to tell their white therapist what it's like on the rez. They wonder why they have to keep explaining and educating her, whereas with me there is none of that. I grew up in these communities. I work in these communities. I'm from these communities.
With our work as professionals and as subject matter experts in our communities, we should be the ones who are being pulled together within your organization to look at this information as the subject matter experts, not the politicians.
5:55 p.m.
Conservative
Jamie Schmale Conservative Haliburton—Kawartha Lakes—Brock, ON
Okay.
That goes to the same thing with the faxes. If they are extremely slow about even changing the way they're doing business to be flexible enough to make changes that are happening on the ground, it's like pushing uphill here.
5:55 p.m.
Lead, Indigenous Initiatives, Canadian Counselling and Psychotherapy Association
Absolutely. That's why I mentioned in my speech, sir, that we're pushing past our human limits. We carry toxic stress with us with each and every generation, so we can advocate and stay alive and not go the way of our ancestors with what was done to them.
We're pushing through these bureaucratic environments that are systemic and that can be overturned by simply changing this policy.
6 p.m.
Conservative
6 p.m.
Liberal
The Chair Liberal Marc Garneau
Thank you very much, Mr. Schmale.
We'll go to Mr. Weiler for five minutes.
6 p.m.
Liberal
Patrick Weiler Liberal West Vancouver—Sunshine Coast—Sea to Sky Country, BC
Thank you, Mr. Chair.
I'd like to thank all of our witnesses for joining us today for this really important study. It's amazing to hear about some of the archaic systems that are still in place right now.
I'd like to start with a question, through you, Mr. Chair, to Ms. Grier.
My colleague MP Battiste had asked all three of our witnesses here about where the federal government investments in indigenous health care can best be placed. I think you were starting to get at some of the investments in mental health. I want to give you the opportunity to really expand on that and share that with this committee.
6 p.m.
Lead, Indigenous Initiatives, Canadian Counselling and Psychotherapy Association
Thank you.
I was just mentioning that, in these unregulated provinces, the fiduciary responsibility the federal government has over first nations under section 91(24) and within the Indian Act is being deferred to provinces to determine our fate. Within first nation communities, we have tirelessly organized politically to try to create unity among chiefs' associations, like AOTC in Alberta, or the chiefs' association in Saskatchewan or Manitoba. These entities are some of the arms that come from the community. No disrespect to the AFN or any of that affiliate, but those chiefs are not elected from our communities. They're elected through regions by the chiefs of those regions. Then the leadership of our communities carry the knowledge of our communities, and their technicians are people like their health directors, who provide them direct information on the ground as to what's happening.
It's really important, and even in our own bureaucracies, we have to try to weed out some of our own political interference in that. How do we get the stakeholder, the actual subject matter expert's voice, like mine or like my supervisor's and so forth, like those of these amazing people I'm with today, to get that direct information, instead of politicizing it and keeping it removed as if it's something on a shelf? This is while we're sitting here struggling and trying to maintain people's lives, trying to keep people alive.
6 p.m.
Liberal
Patrick Weiler Liberal West Vancouver—Sunshine Coast—Sea to Sky Country, BC
Thank you.
You mentioned something else that was very troubling to hear, that just because of some of the bureaucratic troubles with NIHB, some of your colleagues are now moving away from the NIHB program. I'm just curious. Could you speak a little bit more about how they're leaving this program, how their services are being offered and how people can access them?
6 p.m.
Lead, Indigenous Initiatives, Canadian Counselling and Psychotherapy Association
Right now, individuals who are leaving the NIHB program or shying away from it are creating sort of the bottleneck of the wait-list that will occur. Sadly, because the NIHB statisticians here in Ottawa don't have the picture of what's happening on the ground, again it's being reflected in a way that's not accurate.
There are practitioners who have developed competency through working with indigenous communities. You don't get competency just in school. You have to have experiential competency. You have to know the community, participate in the community, be a part of our communities in order for you to say that you are competent. Then you can work because you know our community. Then, of course, you have ethical practice standards and all that continuing education that you do to work towards those competencies.
The truly most competent practitioner is the indigenous practitioner for indigenous people. However, we have a long way to go until we can fill those spaces with full first nation, indigenous practitioners. Until then, we work very hard with our settler populations to ensure that they're competent and that things are indigenous-led. Our indigenous circle chapter has worked tirelessly to create the code of ethics that we implemented from their work on the ground.
I'm not sure if I was answering the question or not.
6 p.m.
Liberal
Patrick Weiler Liberal West Vancouver—Sunshine Coast—Sea to Sky Country, BC
Absolutely, and maybe I'll just direct the last question to Mr. Malak.
On some of these challenges you've raised today, what responses are you getting from NIHB, especially with respect to the major delays that you're experiencing in getting responses?
6:05 p.m.
Pharmacist, Little Current Guardian Pharmacy, As an Individual
According to the people on the phone, it's out of their hands. They don't know. They can't do anything about it. If something's not approved, it's not approved. We can try to appeal it, but it goes to people and then it goes to other people, you know. Then it comes back as “declined”.
6:05 p.m.
Liberal
The Chair Liberal Marc Garneau
Thank you very much.
Go ahead, Madame Gill.
You have two and a half minutes.
6:05 p.m.
Bloc
Marilène Gill Bloc Manicouagan, QC
Thank you, Mr. Chair.
Ms. Tshernish, in response to my last question, you touched on indigenous languages at the end of your answer. If I'm not mistaken, that is the first time the issue was raised in relation to the NIHB program. I'd like to give you an opportunity to finish what you were saying.
Of course, you can also have a few minutes to add any recommendations you may have forgotten to mention earlier.
Tshinashkumitin.
6:05 p.m.
Director, Health Sector, Innu Takuaikan Uashat Mak Mani-Utenam
Tshinashkumitin, Mrs. Gill.
When I mentioned language earlier, I was referring to the holistic way in which the Innu view health. I sincerely believe that language is an integral part in the delivery of health care services to first nations communities. It is a way of safeguarding culture in health care. It is also an important lever in preserving our knowledge and a tool that can support nation-to-nation engagement.
The languages of first nations are obviously very difficult to learn, but I have seen non-indigenous professionals make an effort to reach out to members of our community. The connection that can be formed in communicating with the patient is quite significant. As I said, language can be an excellent lever.
During the earlier discussion about care, someone commented that the tools being used were really archaic, and that struck a chord. That is our experience as well. However, other recommendations could be implemented to make care more accessible. For example, certain clients could automatically have access to escort coverage when receiving care in major centres or tertiary care. Actions could certainly be taken to ease the administrative burden.
Another issue that came up earlier was the wait times for exception drugs. The physician is the one who prescribes the drugs, but the entire NIHB process serves in some ways to challenge what the physician has prescribed. In some cases, the process prevents us from providing the quality care clients are entitled to, and that is wrong.
6:05 p.m.
Liberal
6:05 p.m.
NDP
Lori Idlout NDP Nunavut, NU
[Member spoke in Inuktitut, interpreted as follows:]
Thank you.
I have a question for Ms. Grier.
I enjoyed your presentation.
It is very important that indigenous caregivers, physicians and health professionals look after the community. They are the best people to look after the community. If we indigenous people, I believe, could participate more in health issues and be more involved, we could go a long way in improving health in our own communities. Indigenous people are very qualified when it comes to looking after the lives and health of the people.
Thank you.
6:10 p.m.
Lead, Indigenous Initiatives, Canadian Counselling and Psychotherapy Association
I agree.
I was told one time by one of my teachers that it takes highly qualified and skilled people to work with indigenous people to make a difference. We've seen a lot of people work in our communities, but a quality professional has to know over and above what your average Canadian knows in order to work with our population and make a difference.
I completely agree.
6:10 p.m.
NDP
Lori Idlout NDP Nunavut, NU
[Member spoke in Inuktitut, interpreted as follows:]
Can you give us an example or cite an example so that we have a better understanding? Because we sit here at the committee and we hear things for the first time that are actually happening in the real world, things that we should be administering more carefully, more expediently and more professionally.
What is the best way that indigenous people can get help in health delivery? What are your final thoughts on how best to provide help in health delivery?
6:10 p.m.
Liberal
6:10 p.m.
Lead, Indigenous Initiatives, Canadian Counselling and Psychotherapy Association
I would take out the middleman: fewer Ottawa dollars, more dollars on the ground, more authorities to the first nations and more authorities to the communities. That's really what's going to make the change. We are the experts of our own lives. We do not need dictation from Ottawa anymore to do that—we never did.
Thank you.